Expanding the concept of the toddler's fracture

Fracture of the tibia is a well-known, often occult cause of limping and leg pain in young children. This fracture is typically a hairline, oblique fracture of the shaft of the tibia, and in some cases the fracture can be so subtle that bone scintigraphy or follow-up radiography may be required for its detection. In addition, a variety of other fractures that are less well known and just as difficult to detect can occur in the tibia and the foot in young children. These fractures include plastic bowing and buckle-type fractures, especially of the fibula; impaction, compression, or stress (fatigue) fractures of the tibia and fibula; and fractures of the metatarsal and tarsal bones. All of these fractures can be remarkably similar to the non-displaced spiral tibial fracture in their clinical appearance and should be included under the rubric of "toddler's fracture."